ECMO as a bridging to recovery in a 19-year-old patient with e-cigarette / vaping-product associated lung injury (EVALI)

Introduction: E-cigarettes are becoming increasingly popular among the younger generation An increasing number of e-cigarette or vaping-product associated lung injuries (EVALI) has been published with some severe and even lethal outcomes We report an unusually severe case with veno-venous ECMO being used as a bridging to recovery Case Report: A previously healthy 19- year-old male was admitted to a hospital with shortness of breath He had been suffering from progressive dyspnoea for about four weeks The patient had been a frequent user of e-cigarettes and hookahs Treatment was begun with noninvasive ventilation and continued with endotracheal intubation after rapid deterioration Since hypercarbic pulmonary failure persisted the patient was transferred to an academic referral hospital After a futile conservative approach with prone positioning, veno-venous ECMO was initiated Extensive tests for infectious diseases (including SARS-CoV-2) or autoimmune conditions were nega- tive and the diagnosis of EVALI was made after transbronchial biopsy Steroids and azithromycin were administered, resulting in a slow improvement after three weeks The patient was eventually weaned from ECMO and ventilation after tracheostomy He was discharged to a rehab facility and is now almost asymptomatic However, pulmonary function testing does still demonstrate a marked obstruction predominantly affecting the small airways Conclusion: After exclusion of other causes, and given the appropriate case history, EVALI must be considered as a rare diagnosis for pulmonary failure Since the time to recovery can be substantial, veno-venous ECMO might be a therapeutic option bridging the patient until pulmonary function improves Early transfer to a specialised facility appears appropriate